in this video we're gonna talk about acute otitis media drive to the greek word ott which means eeeh itis which means inflammation and from latin media which is something pertaining to the middle acute otitis media is infection of the middle ear and it is a very common problem in children now the majority of children will be diagnosed with at least one episode of a titus media the ear plays a key role in hearing the ear is divided into three parts the inner middle and outer ear the basic physiology of the ear involves sound waves hitting and vibrating the tympanic membrane the tympanic membrane moves the three small bones of the middle ear the malleus incus and stapes the movement of the stabies causes the fluid in the cochlea to vibrate the cochlear cells will translate this vibration information into nerve impulses and essentially send it to the brain where sound is perceived the eustachian tube is the connection between the middle ear and the nasal pharynx or the nasal cavity the middle ear cleft is made up of the mastoid air cells posterior to the middle ear cavity the eustachian tube and the nasal pharynx the middle ear cleft can be thought of as a miniature lung these areas involved allow for ventilation and pressure equalization and issues and any issues that occur within these areas can result in middle ear pathologies the station tube is a pretty important structure and serves many roles it permits equilibration of middle ear pressure with atmospheric pressure it's the primary defense mechanism of the middle ear it protects the middle ear from reflux of nasopharyngeal secretions through the use of cilia propelling unwanted substances to the nasopharynx and thirdly it drained secretions from the middle ear into the nasopharynx because of the angle acute otitis media mainly occurs in children and as a result of eustachian tube dysfunction if the station tube does not work a terrace media can develop for example infection or a reaction in the middle ear cleft can result in edema swelling of the eustachian tube similarly adenoids hypertrophy from an infection can block you station ship drainage and disrupt pressure equalization resulting in negative pressure in the middle ear another cause of your station to dysfunction is failure of some of the muscles that connect or wrap around or passed through the station tube this include failing of the tensor veli palatini and lovato veli palatini these muscles help in opening key station - but are primarily used and involved in swallowing and yawning otitis media is more common in children precisely because of the anatomical differences of the eustachian tube between children and adults unlike adults eustachian tube the child's eustachian tube is more shorter horizontally aligned it's softer and has a smaller passageway and all this allows for easier spreading of infection from the nasal pharynx into the middle ear the pathophysiology of acute otitis media follows a few stages one thing that people are often confused about is all the terminology used in otitis media such as Terrace media with effusion acute otitis media suppurative otitis media etc so hopefully understanding the pathophysiology and the going step by step can help clear this off so let's begin with the viral upper respiratory tract infection that has happened for a few days this eventually causes congestion and swelling of the nasal mucosa the nasal pharynx and swelling of the eustachian tube eustachian tube occlusion results in increased negative pressure in the middle ear and accumulation of middle ear secretions secondary bacterial or viral infections can occur in this environment which will cause further separation and features of acute otitis media remember acute otitis media is a bacterial or a viral infection of the middle ear however in this closed environment like what we discussed certain bacteria thrive the main causative bacterial agents in acute otitis media are streptococcus pneumoniae non-type herbal Hema floss influenza and Moraxella catarrhalis if the pressure becomes too great in the middle ear because of fluid building up the tympanic membrane can perforate this is called suppurative otitis media suppurative otitis media is characterized by ear discharge termed urea suppurative otitis media can become chronic and thus is termed chronic suppurative otitis media sometimes it resolves and the perforated membrane heals and returns to a new baseline if the inflammation in the middle ear settles there is a resolution of symptoms usually however there is often residual fluid in the middle ear cavity residual fluid in the middle ear cavity after acute otitis media it's termed otitis media with effusion Attalla see media with effusion is usually asymptomatic and resolves by itself after three months without doing anything unfortunately even though at itis media with effusion is asymptomatic it is still a potential environment for a reinfection and this can thus cause recurrent acute otitis media get a summary diagram of acute otitis media now taking all the pathophysiology into context acute otitis media classically presents with italia ear pain pyrexia fevers hearing loss and maria through the perforation of the tympanic membrane other symptoms in children include irritability reduced appetite upper respiratory tract infections and fatigue otitis media with effusion is usually asymptomatic as explained previously and typically follows an episode of acute otitis media hearing loss is the other main complaint hearing loss occurs because the tympanic membrane and auditory ossicles are unable to move as effectively in an environment full of fluid and inflammation hence in the presence of an infusion there can be a conductive hearing loss rather than a sensory neural hearing loss diagnosis of acute otitis media and otitis media with effusion can be diagnosed by direct visualization of the tympanic membrane with an otoscope or a pneumatic otoscope in acute otitis media the eardrum looks inflamed injections of the vessels of the tympanic membrane to reddening with bulging of the eardrum is present using a pneumatic otoscope there is limited or absent mobility of the membrane here's an image of an otoscope visualization of someone who has acute otitis media note the bulging eardrum and blood vessels if there is perforation of the eardrum with discharge this is termed suppurative otitis media here is an image through an otoscope of someone with a suppurative acute otitis media note the discharge that is coming out once diagnosis of acute otitis media is suspected a period of observation is recommended typically 24 to 48 hours is recommended exceptions exist for high-risk groups and persistent infections the overuse of antibiotics may contribute to increasing antimicrobial resistance pain and fever in acute otitis media should be controlled with paracetamol or ibuprofen if symptoms do not improve with analgesia after 48 hours then a course of antibiotics is commenced typically this is amoxicillin decongestants and antihistamines are not beneficial in the treatment of acute otitis media when acute otitis media resolves it then really becomes a Tidus media with effusion usually in a Tallis media with effusion autoscopic findings include visualization of air fluid levels with bulging and maybe decreased mobility of the tympanic membrane there is no evidence of a red sore ear drum here is an image of a otoscope visualization of someone who has a tardis media with effusion note the fluid behind the tympanic membrane ricardo téllez media are persistent Attalus media with effusion may require ventilation tubes known as timpanist to me cubes especially the child has features of hearing loss developmental delays or learning difficulties it is also important to follow up on the child after episodes of an acute otitis media and to tell the parents to return if symptoms worsen as this could be signs of complications associated with acute otitis media rare complications of acute otitis media can be divided into extra cranial and intracranial complications most of the complications of acute otitis media is a result of direct extension of the infection the pass to the mastoid air cells which are situated behind the posterior wall of the middle ear cavity basically extension into the mastoid air cells causes mastoid itis other complications of acute otitis media can include intracranial abscesses including subdural abscess and subarachnoid abscess there can also be subperiosteal abscesses facial nerve palsy can be also a complication as well as labyrinthitis a more comprehensive video on the complications of acute otitis media and mastoid itis will be available adults can also present with acute otitis media and treatment is roughly the same remember acute otitis media is a very common problem in children the majority of children will be diagnosed with at least one episode of otitis media management actually relies on a period of observation first typically 24 to 48 hours before commencing antibiotics thank you for watching